Functional Outcome of Distal Third Tibial Fractures Treated by Posterior versus Medial Plating – A Prospective Comparative Study

Introduction: Distal third tibial fractures pose a unique surgical challenge due to minimal soft-tissue coverage, subcutaneous bone location, and high risk of malalignment or delayed union. Among internal fixation options, posterior and medial plating are widely practiced, but comparative evidence regarding early functional recovery and radiological alignment remains limited. Materials and Methods: This prospective randomized study included 36 adults with Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association Type A and B distal third tibial fractures treated by either posterior plating (n = 18) or medial plating (n = 18) using 3.5 mm locking compression plates. Standardized perioperative care and identical rehabilitation protocols were applied. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Score at 2, 4, and 8 weeks. Radiological alignment and union were evaluated at 2, 4, 8 weeks, and 6 months. Statistical analysis was performed using unpaired t-tests and Chi-square tests with significance at P < 0.05. Results: The mean participant age was 42.5 ± 12.3 years, with an equal male-to-female ratio. Posterior plating demonstrated significantly higher AOFAS scores at 2 weeks (66.5 ± 2.33 vs. 64.7 ± 2.34; P = 0.029) and at 8 weeks (87.6 ± 2.50 vs. 85.0 ± 2.49; P = 0.004), suggesting faster early functional recovery. Radiographically, 94.4% of posterior-plated fractures achieved acceptable alignment compared with 77.8% in the medial group. All fractures united by 6 months, and no non-union or implant failure occurred. Superficial wound irritation occurred in two medial cases only. Conclusion: Posterior plating provides superior early function and improved alignment while maintaining the same union rate and complication profile as medial plating. These findings validate posterior plating as a safe, mechanically advantageous, and soft-tissue-friendly option for distal third tibial fractures. Keywords: Distal tibia, posterior plating, medial plating, American Orthopedic Foot and Ankle Society, radiological union, fracture fixation.